Child Drowning

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5.2 BUILDING DROWNING PREVENTION CAPACITY AT ALL LEVELS To produce a significant reduction in the burden of drowning in LMIC’s substantial investment is needed in building capacity at all levels of the development continuum. At national level there needs to be recognition that drowning prevention requires multisectoral collaboration. Fundamental to this is ensuring that the limited resources and focus of key groups and government agencies are aligned to boost the overall capacity of the system to reduce drowning. This pressure is accentuated in LMICs given the emerging nature of the drowning issue on the public health agenda. It may raise dissent or disinterest among many already engaged in child mortality reduction as ‘mission creep’, and may be seen as another set of interventions for which staff and funding is unavailable. The newly available evidence on the significance of the drowning epidemic among children in Asian LMICs may help overcome some of these objections. National responses to drowning prevention are impeded by a lack of technical and operational capacity, such as limitations in the skills required to teach survival swimming or to manage large-scale survival swimming programmes. The PRECISE project in Bangladesh and the SwimSafe Danang programme in Viet Nam have aimed to build community and government capacity to implement and monitor drowning prevention programmes in the respective areas. In Bangladesh, the number of survival swimming instructors has grown exponentially since the programme was first developed. This has been achieved through the standardization of instructional resources, recruitment of community-based instructors and supervision models that delivered on-the-job mentoring and professional development. External supervision and certification was crucial to the project’s success. In Viet Nam, schoolteachers across the province were trained and had regular supervision and professional development conducted by master trainers under external supervision. The resulting cadre of survival swimming instructors is now in demand by the Vietnamese Ministry of Education and Training and other programme managers, who recognize the advantages of having Vietnamese master trainers. Building the capacity to implement, manage and monitor drowning prevention programmes is essential, but focus must also be given to the issue of elevating drowning prevention into national government priorities, increasing the availability of funds and devising systems and plans to prevent and reduce drowning nationally. Success in this area is premised on an acceptance that drowning prevention requires multisectoral collaboration. Lifesaving agencies and drowning prevention specialists in HICs have come to this recognition, after having worked with limited and fragmented resources for many years, frequently compromising the effectiveness of their efforts. For example, much of the drowning prevention efforts in Australia have been driven at community level through volunteer lifesaving models, and academics often lament the lack of funds available to support or strengthen the evidence base for prevention. Multisectoral collaboration builds on the strength of each sector, and can result in additional fundraising and strengthened advocacy for prevention of child drowning. In recent years, LMICs too have recognized the need for a multisectoral approach. In Viet Nam, with assistance from UNICEF and WHO, the Government formed an Inter-Ministerial Panel for Child Drowning Prevention in 2009 to coordinate the work of a range of government agencies on drowning prevention. Other models exist and an example is the Philippine Life Saving Society. PLSS has initiated the Philippine Drowning Prevention Council as a strategy to formulate plans, engage all sectors and increase government involvement in drowning prevention. In both cases large community surveys that mapped the scale and patterns of drowning were conducted. While it has taken some time, this research and others like it has contributed to the elevation of drowning among key government and NGO sectors, stimulating drowning prevention interventions and prompting recognition of the need for multisectoral approaches and the development of drowning prevention capacity. 70
5.3 STIMULATING AND SUSTAINING INVESTMENT IN DROWNING PREVENTION While the newly available evidence on drowning has spurred prevention activities in each of the countries surveyed, it is clear that LMICs cannot effectively address the issue on their own. Just as global health partnerships have informed the child health and development communities in areas such as malaria, immunizations and tuberculosis, drowning prevention advocates can and should utilize global health partnership models to initiate action at regional or global levels to support efforts being undertaken in LMICs with high drowning rates. As an example, global efforts to eradicate malaria have taken many forms in the last four decades. A review of limitations of the first attempts resulted in a more recent approach, Roll Back Malaria, which is based on progressive scale-up of a package of interventions, global partnerships and national action plans. Drowning prevention advocates may take lessons from the GAVI Alliance approach to publicprivate sector partnerships, governance and attracting investment from governments and philanthropists, or from the focus of the Global Fund to Fight AIDS, Tuberculosis and Malaria, on raising funds, coordinating donors and monitoring results. Partnership models in other sectors including disaster risk reduction, water and sanitation and rural development also reinforce the need for coordinated planning by drowning prevention advocates. The collaborative plans in these sectors may be particularly relevant to drowning prevention given the overlapping constituents in LMIC’s. For example, many of the communities with high rates of drowning in Bangladesh rely heavily on rural agriculture and are vulnerable to disasters such as severe flooding and coastal inundation. While starting from a low base of support, drowning prevention is not without global or regional advocates. The International Life Saving Federation (ILSF) is made up of national lifesaving and drowning prevention bodies and collaborative partners across all regions. Its mission is to act as the world authority on drowning prevention, lifesaving and lifesaving sport, and among many initiatives convenes a bi-annual global conference on drowning prevention. Influenced heavily by the findings of the first UNICEF-TASC special series of working papers on child injury published in 2007, the World Conference on Drowning Prevention was held in May 2011 in Danang, Viet Nam. At this event, a diverse cross-section of stakeholders, including representatives from UN agencies, international and national lifesaving federations, regional governments and the research sector convened to address the issue of drowning prevention at global, regional and national levels. A key outcome of the event was the initiation a global platform to reduce drowning. 5.4 MANAGING THE SHIFT FROM SCARCE FUNDS TO WELL-TARGETED, COORDINATED INVESTMENTS The Global Platform to Reduce Drowning seeks to establish a dialogue among high-level stakeholders with an interest in elevating drowning as a public health issue worldwide. With growing awareness, consensus and concern about the need to act to prevent drowning, the stakeholders represented at the ILS World Conference on Drowning Prevention 2011 called for well-targeted and coordinated investments, and the need to capitalize on momentum being generated for drowning prevention efforts in Asia. The results of their efforts, the Global Platform to Reduce Drowning, aims to provide a vehicle for lifesaving organizations, multilaterals, national governments and partners across the drowning prevention and development sectors to explore multisectoral collaboration. The principles outlined in the Platform are as follows: 71
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UNICEF Office of Research Child Dro
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THE UNICEF OFFICE OF RESEARCH In 19
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TABLE OF CONTENTS Executive Summary
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EXECUTIVE SUMMARY Childhood drownin
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Household survey findings Drowning
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Loss of health and social investmen
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INTRODUCTION Children living in dev
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(iii) Methodology: Most surveys ha
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Proportion of drowning Figure 1: Dr
Page 19 and 20: In high-income countries (HICs), be
Page 21 and 22: Table 2: ICD-10 drowning (1997) W65
Page 23 and 24: - had no data reported, or none rep
Page 25 and 26: data from multiple sources includin
Page 27 and 28: A combination of these approaches i
Page 29 and 30: Mortality rate/1,000 Drownng propor
Page 31 and 32: Figure 7: Mortality among children
Page 33 and 34: A second conclusion is that the cur
Page 35 and 36: Cumulative proportion Drowning rate
Page 37 and 38: Table 6 shows the severity of the n
Page 39 and 40: Bangladesh Jiangxi China Cambodia B
Page 41 and 42: 1. Drowning risks are higher when c
Page 43 and 44: Rate per 100,000 Figure 17: Cause o
Page 45 and 46: Figure 19: Resuscitation received b
Page 47 and 48: drowning. It states: “Unprecedent
Page 49 and 50: esult, children fall in and drown,
Page 51 and 52: Drowning rate per 100,000 2.6 LEVEL
Page 53 and 54: 3. EVIDENCE FOR PREVENTION It is of
Page 55 and 56: drowning is a leading but preventab
Page 57 and 58: Mortality Rate (per 1,000) Figure 2
Page 59 and 60: The analysis allowed examination of
Page 61 and 62: Table 9: Number of children needed
Page 63 and 64: The intervention developed a formal
Page 65 and 66: immediate resuscitation is discusse
Page 67 and 68: 2011) has 107 indicators, but does
Page 69: systems and standards, and manageme
Page 73 and 74: effective against ‘other diseases
Page 75 and 76: ANNEX: LIST OF CONTRIBUTORS This pa
Page 77 and 78: STAFF AND VOLUNTEERS OF THE ROYAL L
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Child Drowning

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